Clapper, Patti, Schweizer and Mason

Malignant mesothelioma is a rare, aggressive, and treatment resistant cancer, with increasing number of cases being diagnosed each year worldwide. The main risk factor is exposure to asbestos. There is a long latency period of ten to forty years between time of exposure and development of symptoms, making the disease difficult to diagnose in early stages.

 

The molecular pathology and biological behavior of mesothelioma is unusual because of a decrease in tumor suppressor genes which causes rapid progression and recurrence after treatment. Median survival time for mesothelioma is less than a year from time of diagnosis. Treatments are generally palliative as there is currently no known cure for mesothelioma.

 

Multimodality treatment of mesothelioma, particularly malignant pleural mesothelioma, has shown some promise to extend survival time in patients that have favorable prognosis and performance status. Multimodality treatment usually refers to combining two or more standard front line therapies: surgery, radiation therapy, and adjuvant or neoadjuvant chemotherapy. Single treatment approaches have produced little success.

 

In addition to front line therapies, innovative treatments for mesothelioma are currently being researched. Some of these include:

 

Best results often occur when surgery is possible and combined with post-operative adjuvant therapies. Surgical options could be an extra-pleural pneumonectomy (EPP) for patients with less advanced mesothelioma, or pleurectomy or decortication for those with more advanced disease. Results from a recent study looking at research from medical centers throughout the United Kingdom show that combining pleurectomy/decortication surgery with chemotherapy or radiotherapy leads to longest survival times.  

 

Research into the underlying causes, improved diagnostic tools, and optimal treatment strategies show promise for the future. For now, a multimodality approach of combining surgery with post-operative chemotherapy and radiotherapy shows highest survival benefit.